BACKGROUND: Depression is an underrecognized and undertreated condition in Parkinson's disease (PD). The development of updated, individualized management strategies represents an important unmet need for clinicians and...BACKGROUND: Depression is an underrecognized and undertreated condition in Parkinson's disease (PD). The development of updated, individualized management strategies represents an important unmet need for clinicians and care providers. This review examines the use of trazodone, focusing on its mechanism of action, and proposes a practical algorithm for its use in the management of depression in patients with PD. MATERIALS AND METHODS: Seven neurologists, experts in movement disorders took part in a structured panel on depression management to exchange ideas and experiences for the implementation of best practice. RESULTS: The experts agreed that trazodone can be beneficial in PD patients with comorbid depression. The treatment algorithm proposed considers patients in early or more advanced stages of PD. In early stages with mood alterations and anxiety, the suggested treatments are a mood stabilizer, trazodone, or a tricyclic antidepressant. Serotonergic therapy or an SNRI should be considered for patients with low mood but no agitation. In presence of depressive mood with predominant insomnia, high-dose trazodone should be considered along with mirtazapine. In more advanced stages, in the presence of cognitive deficits without agitation low to medium dose trazodone can be considered along with mirtazapine. In case of cognitive deficits with agitation, low to medium dose trazodone is suggested. CONCLUSIONS: The proposed algorithm may assist neurologists in the management of depression in patients with PD by providing specific recommendations on the role of trazodone across different clinical scenarios, allowing for individualized treatment.
BACKGROUND: While the aetiology of Parkinson's disease (PD) involves genetic and environmental factors, emerging evidence has suggested a surprising link between lipid metabolism - particularly serum total cholesterol (T...BACKGROUND: While the aetiology of Parkinson's disease (PD) involves genetic and environmental factors, emerging evidence has suggested a surprising link between lipid metabolism - particularly serum total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) - and the pathogenesis of PD. Cholesterol plays a vital role in neuronal membrane integrity, myelination, and synaptic function. However, its peripheral concentration and regulatory mechanisms in the central nervous system (CNS), remain incompletely understood in the context of PD. OBJECTIVE: This review aims to systematically examine the current literature on the relationship between TC and LDL-C with the risk and progression of PD in longitudinal patient cohorts. METHODS: A systematic literature search was conducted using PubMed with the keywords "Parkinson's disease" AND "cholesterol" and "Parkinson's disease" AND "LDL." Inclusion criteria encompassed English-language longitudinal human studies published before October 2024, with data on cholesterol levels in relation to PD incidence or progression. Fourteen studies met the eligibility criteria. RESULTS: Twelve of the 14 included studies reported an inverse association between lower serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels and increased risk for PD onset as well as faster disease progression. Notably, this pattern was not uniform across all subgroups: age, sex, BMI, and statin use modulated the strength and direction of associations. CONCLUSION: Despite some heterogeneity across studies, there is growing evidence that lower TC and LDL-C may be associated with a higher risk and more rapid progression of PD. Future research should focus on mechanistic studies and stratified analyses to clarify whether and how cholesterol modulation could contribute to neuroprotective strategies in PD.
BACKGROUND: Understanding whether commonly available metabolic, demographic, and behavioral factors can explain variability in brain structure may support the development of accessible predictive approaches. This study a...BACKGROUND: Understanding whether commonly available metabolic, demographic, and behavioral factors can explain variability in brain structure may support the development of accessible predictive approaches. This study aims to evaluate the ability of machine learning regression models to predict brain structural measures in young, neurologically healthy adults using clinically accessible risk factors. METHODS: Data were drawn from the Human Connectome Project Young Adults dataset, including 1082 participants aged 22-37. Predictors comprised metabolic measures (systolic and diastolic blood pressure, hematocrit, body mass index, hemoglobin A1C, thyroid stimulating hormone) and demographic/behavioral variables (age, gender, race, education level, smoking history, alcohol use). Brain structural parameters from MRI included gray matter (GM) and white matter (WM) volumes, surface areas, and cortical thickness. Distance correlation (dcor) guided feature selection, followed by machine learning modeling. Model performance was evaluated using normalized mean absolute error (NMAE), normalized root-mean-squared error (NRMSE), and coefficient of determination (R²). SHAP values were used for feature interpretation. RESULTS: XGBoost consistently outperformed other algorithms, showing strong predictive accuracy for total brain segmentation, supratentorial, and total GM volumes (NMAE < 0.35, R² > 0.80). In contrast, cortical surface predictions (left superior frontal) showed moderate performance (NMAE > 0.50, R² < 0.60). SHAP analysis highlighted age, gender, education level, and diastolic and systolic blood pressure as the most influential predictors of brain structure. CONCLUSIONS: The findings highlight the methodological value of regression-based approaches for estimating brain structural variability and support their potential role as complementary tools for brain health research.
This article offers a historical reassessment of the Iconographie photographique de la Salpêtrière on the 150th anniversary of its first volume (1876), situating its images within the technical and cultural conditions of...This article offers a historical reassessment of the Iconographie photographique de la Salpêtrière on the 150th anniversary of its first volume (1876), situating its images within the technical and cultural conditions of nineteenth-century photography. Long exposure times and wet-collodion plates meant that the photographs produced by Guillaume Duchenne de Boulogne (1806-1875), Désiré-Magloire Bourneville (1840-1909), and Paul-Marie-Léon Regnard (1850-1927) were necessarily staged, drawing on the visual conventions of academic painting and theatrical culture rather than capturing neurological events in real time. These constraints shaped the representation of hysteria and explain the parallel use of drawn illustrations to depict movements too rapid for the camera. A major shift occurred only with Albert Londe (1858-1917), whose adoption of gelatin-silver bromide plates and multi-lens cameras in the 1880s enabled instantaneous exposures and the sequential recording of motion. By placing the Iconographie between earlier pictorial traditions and emerging scientific aspirations, the article shows that its images are indexical traces of constructed scenes, revealing the interplay between photographic technology, medical pedagogy, and visual culture in the late 19th Century.
AIMS: This review aims to explore the potential role of oral antipyretics (aspirin (ASA)/ acetaminophen), commonly known for fever and pain control, in managing fatigue, temperature regulation, and exercise capacity in p...AIMS: This review aims to explore the potential role of oral antipyretics (aspirin (ASA)/ acetaminophen), commonly known for fever and pain control, in managing fatigue, temperature regulation, and exercise capacity in patients with Multiple Sclerosis (MS), with a focus on nursing implications for symptom management. DESIGN: A systematic review of existing clinical studies assessing the effects of aspirin/ acetaminophen on MS-related fatigue, thermoregulation, and exercise performance. DATA SOURCES: Electronic databases including Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PubMed, Scopus, Web of Science, Wiley, Google Scholar, and ClinicalTrials.gov were searched up to March 2024. REVIEW METHODS: Quality assessment was conducted using the Cochrane risk of bias tool 2. to evaluate the methodological rigor of included studies. Outcomes analyzed included clinically assessed fatigue scores, exercise endurance, and post-exercise thermoregulation, with attention to potential risks associated with aspirin use. RESULTS: After assessment of 57 reports for eligibility, only seven studies met inclusion criteria; results indicated that aspirin pretreatment significantly improved Time to Exhaustion (TTE) in heat-sensitive MS patients (p = 0.013), though one study reported no significant effect. Aspirin reduced post-exercise temperature rise by 56%, but this was not statistically significant in one trial (p = 0.178), while another showed significant reductions (p = 0.002). CONCLUSION: Aspirin and acetaminophen may offer benefits in alleviating fatigue, enhancing thermoregulation, and improving exercise endurance in MS patients. These findings suggest that nurses should consider the potential role of aspirin in symptom management, with further research needed to confirm efficacy and safety. IMPACT: This review highlights a potential adjunct therapy for nurses to incorporate into comprehensive MS care, emphasizing symptom control and quality of life improvements. PATIENT OR PUBLIC CONTRIBUTION: Not applicable. TRIAL REGISTRATION: This review is PROSPERO registered having ID CRD420251000875.
INTRODUCTION: Cluster headache (CH) is a severe unilateral trigeminal autonomic cephalalgia with limited well tolerated therapies. Calcitonin gene related peptide monoclonal antibodies, including galcanezumab, fremanezum...INTRODUCTION: Cluster headache (CH) is a severe unilateral trigeminal autonomic cephalalgia with limited well tolerated therapies. Calcitonin gene related peptide monoclonal antibodies, including galcanezumab, fremanezumab, and eptinezumab, have established efficacy in migraine and are under evaluation in CH. This study assesses their efficacy and safety using pairwise and network meta analysis. METHODS: PubMed, Embase, Scopus, and ClinicalTrials.gov were searched through April 2025. Randomized controlled trials enrolling adults with episodic or chronic CH were included. The primary endpoint was change in weekly attack frequency. Secondary outcomes included subtype specific effects and adverse events. Frequentist random effects network meta analysis and pairwise meta analysis were performed in R. RESULTS: Five trials with approximately 1,000 participants were included. No agent demonstrated statistically significant reduction in weekly attack frequency versus placebo, although consistent numerical improvements were observed. Dose specific network estimates showed mean differences of - 0.81 for galcanezumab 300 mg, - 0.17 for eptinezumab 400 mg, 0.71 for fremanezumab 675/225 mg, and - 1.27 for fremanezumab 900/225 mg. Pooled dose estimates were - 0.81 for galcanezumab, - 0.27 for fremanezumab, and - 0.17 for eptinezumab. Pairwise meta analysis yielded a pooled mean difference of - 0.41. Subgroup analysis indicated minimal change in chronic CH and greater numerical reduction in episodic CH. CONCLUSION: CGRP monoclonal antibodies demonstrate modest directional reductions in attack frequency without statistical significance. Signals appear more pronounced in episodic CH, supporting the need for adequately powered, subtype specific trials.
BACKGROUND: Parkinson's disease (PD) is a progressive neurodegenerative disorder with no proven disease-modifying therapies to date. Because changes in cerebral glucose metabolism and insulin resistance have been linked...BACKGROUND: Parkinson's disease (PD) is a progressive neurodegenerative disorder with no proven disease-modifying therapies to date. Because changes in cerebral glucose metabolism and insulin resistance have been linked to PD pathophysiology, glucagon-like peptide-1 receptor agonists (GLP-1RAs), widely used for diabetes, have been investigated as potential neuroprotective treatments. METHODS: This study systematically assessed the efficacy and safety of GLP-1RAs in PD through a systematic review and meta-analysis of randomized controlled trials identified in PubMed, Embase, and the Cochrane Library. The primary outcomes were motor function improvements measured by the MDS-UPDRS Part III in both on- and off-medication states at study endpoints and at intermediate timepoints of interest. Secondary outcomes included MDS-UPDRS Parts I, II, and IV, quality of life assessed by the PDQ-39, levodopa equivalent daily dose (LEDD), and the occurrence of adverse events. RESULTS: The meta-analysis found no statistically significant difference in favor of GLP-1RAs over placebo for motors and non-motors outcomes, except for PDQ-39 (MD: - 0.75; 95% CI: [- 1.34, - 0.17], P = 0.01). Regarding safety, GLP-1RAs were associated with a higher incidence of adverse events, especially gastrointestinal effects such as nausea, vomiting, and constipation. CONCLUSIONS: Overall, current evidence does not demonstrate consistent clinical benefit of using GLP-1RAs for treating motor or non-motor symptoms in PD nor support GLP-1RAs as disease-modifying therapy, underscoring the need for further research.
Central nervous system Burkitt lymphoma (BL) is exceptionally rare in adolescents without systemic disease. We report a 16-year-old female presenting with progressive headaches and isolated fornix lesions on MRI. Followi...Central nervous system Burkitt lymphoma (BL) is exceptionally rare in adolescents without systemic disease. We report a 16-year-old female presenting with progressive headaches and isolated fornix lesions on MRI. Following an initial presumptive diagnosis of viral encephalitis, empiric administration of low-dose dexamethasone and antivirals induced transient symptomatic improvement. A follow-up MRI 50 days later revealed a fulminant "spark-to-wildfire" imaging progression, characterized by multifocal ventricular dissemination and obstructive hydrocephalus. Histopathology and fluorescence in situ hybridization (FISH) confirmed the BL diagnosis. This case highlights the extreme biological aggressiveness of central nervous system BL and the diagnostic challenges of atypical fornix involvement, underscoring the necessity of serial neuroimaging assessment and prompt pathological biopsy for accurate diagnosis.
INTRODUCTION: Spinal cord infarction (SCI) is a rare but severe cause of acute myelopathy, and evidence supporting reperfusion therapies remains limited. METHODS: We report a 73-year-old man with spontaneous cervical SCI...INTRODUCTION: Spinal cord infarction (SCI) is a rare but severe cause of acute myelopathy, and evidence supporting reperfusion therapies remains limited. METHODS: We report a 73-year-old man with spontaneous cervical SCI treated with intravenous alteplase and perform a systematic review (database search from inception to 13 November 2025) of case reports/series describing intravenous (IV) or intra-arterial (IA) thrombolysis for SCI, extracting data about clinical presentation, diagnostic and therapeutic work-up and functional outcomes. RESULTS: Our patient improved after thrombolysis and achieved functional independence at 3 months (modified Rankin Scale [mRS] 2). The review identified 21 studies (19 case reports, 2 case series) totaling 25 patients; including our case, 26 patients were analyzed. Mean age was 57.4 years (range 14-83), and anterior spinal artery (ASA) syndrome was the most common presentation. Most patients received IV thrombolysis; 4 underwent IA therapy (alone or combined). Considering the last available assessment, 14/25 patients (56.0%) had a favorable outcome (mRS 0-2), 8/25 (32.0%) had mRS 3, and 3/25 (12.0%) had mRS 4-5. No symptomatic treatment-related hemorrhagic complications were reported. DISCUSSION AND CONCLUSION: Published experience suggests that thrombolysis in carefully selected patients with suspected SCI may represent a reasonably safe therapeutic option, but evidence is limited and subject to major bias. Prospective registries and multicenter studies are needed to clarify safety, efficacy, and selection criteria.
BACKGROUND: Adaptive deep brain stimulation (aDBS) dynamically modulates stimulation parameters in real time based on ongoing neural activity, potentially overcoming key limitations of conventional continuous DBS (cDBS)...BACKGROUND: Adaptive deep brain stimulation (aDBS) dynamically modulates stimulation parameters in real time based on ongoing neural activity, potentially overcoming key limitations of conventional continuous DBS (cDBS) in Parkinson's disease (PD). OBJECTIVES: To assess the impact of switching from cDBS to aDBS on motor and non-motor symptoms in PD patients with suboptimal cDBS outcomes. METHODS: Four PD patients transitioned from optimized cDBS to aDBS using threshold algorithms tailored to beta-band activity. Motor and non-motor outcomes were assessed before surgery, under cDBS, and 9 months after aDBS using MDS-UPDRS parts I-IV, PDSS-2, and PDQ-39. RESULTS: aDBS reduced motor complications (ΔUPDRS-IV: -40.4%), while maintaining motor benefit. Patients showed improved sleep (ΔPDSS-2: -52.9%), improvement in non-motor and motor aspects of daily-living (ΔUPDRS-I: -43.6%; ΔUPDRS-II:- 31.3%), and quality-of-life (ΔPDQ-39: -24.7%). No adverse effects occurred and all patients preferred aDBS over cDBS. CONCLUSIONS: aDBS was feasible, well tolerated, and improved motor fluctuations and sleep quality compared with cDBS, supporting its role in personalized neuromodulation for PD.
BACKGROUND: Postoperative myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) represents a rare clinical entity that poses significant diagnostic challenges. Despite its clinical relevance, limited at...BACKGROUND: Postoperative myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) represents a rare clinical entity that poses significant diagnostic challenges. Despite its clinical relevance, limited attention has been directed toward postoperative MOGAD, compounded by its heterogeneous symptom presentation and potential mimicry of other postoperative complications. This case study provides critical insights into the diagnostic and therapeutic management of postoperative MOGAD, emphasizing the necessity for early recognition and appropriate treatment. We present a case of a 27-year-old female who developed refractory fever following transforaminal lumbar interbody fusion (TLIF) surgery. Initial treatment focused on suspected surgical site inflammation, with empirical broad-spectrum antibiotics administered. However, progressive neurological manifestations including bilateral vision impairment, headache, and positive serum MOG-IgG prompted revision of the diagnosis to MOGAD. The patient subsequently received targeted therapy and recovered well. RESULTS: The patient received methylprednisolone, mannitol, and intravenous immunoglobulin therapy. This regimen achieved complete neurological recovery, with resolution of visual deficits and normalization of inflammatory markers. CONCLUSION: This case highlights the importance of identifying postoperative MOGAD as a potential complication and underscores the need for early and accurate diagnosis. Increased awareness and prompt intervention could prevent unnecessary delays in treatment and improve patient prognosis.
BACKGROUND AND OBJECTIVES: Migraine is a primary headache disorder wherein vascular changes are well known. We aimed to evaluate the retinal and choroidal parameters in migraine patients longitudinally, with a particular...BACKGROUND AND OBJECTIVES: Migraine is a primary headache disorder wherein vascular changes are well known. We aimed to evaluate the retinal and choroidal parameters in migraine patients longitudinally, with a particular focus on treatment-related changes. METHODS: We conducted a prospective longitudinal study of 45 patients with migraine (ICHD-3 criteria) who were indicated for prophylactic treatment. The patients were evaluated clinically using the visual analogue scale (VAS), monthly migraine days (MMD), migraine disability assessment score (MIDAS), and Optical Coherence Tomography (OCT) at baseline and after 3 months of follow-up. The peripapillary retinal nerve fibre layer (PPRNFL), peripapillary choroid thickness (PPCHT), subfoveal choroid thickness (SFC), ganglion cell layer (GCL), and central macular thickness (CMT) were the parameters assessed using OCT. 45 age- and gender-matched healthy controls were recruited for comparison of baseline parameters. RESULTS: The majority of patients (38/45) were females, and the mean age was 37.3 ± 10.0 years. The PPRNFL, PPCHT, SFC LE, GCL, and CMT were thinner in patients than in controls. All parameters, except the GCL and CMT, increased significantly during follow-up after 3 months of prophylactic treatment. CONCLUSION: This longitudinal study demonstrated partial structural recovery, suggesting that some retinal and choroidal changes in migraine may be reversible. Our findings support the role of these OCT parameters as surrogate markers of disease burden and treatment response in migraine. Large-scale, multicentre prospective studies with longer follow-up are warranted to evaluate the prognostic utility of OCT parameters in migraine.
BACKGROUND: An increasing number of Culturally and Linguistically Diverse (CALD) patients have sought cognitive assessment in Italian Centers for Cognitive Disorders and Dementia (CCDDs) in recent years; however, validat...BACKGROUND: An increasing number of Culturally and Linguistically Diverse (CALD) patients have sought cognitive assessment in Italian Centers for Cognitive Disorders and Dementia (CCDDs) in recent years; however, validated cross-cultural cognitive tools in Italian remain limited. The Rowland Universal Dementia Assessment Scale (RUDAS) and the European Cross-Cultural Neuropsychological Test Battery (CNTB) were developed to minimize linguistic and cultural bias. OBJECTIVE: To translate and culturally adapt the RUDAS and CNTB into Italian for use in Italian CCDDs, both with native Italian speakers and with CALD patients assessed via trained cultural mediators. METHODS: A step-by-step methodology was applied: forward translation, synthesis I, blind backward translation, synthesis II, and cognitive debriefing. Two bilingual and bicultural translator pairs completed the translations. Pre-final versions were tested in 40 monolingual Italian participants (8 mild cognitive impairment, 8 dementia, 24 healthy controls; mean age 71.4 ± 10.1 years; mean education 9.9 ± 3.8 years). The purpose of this phase was exclusively to evaluate comprehensibility, conceptual clarity, and cultural appropriateness; no psychometric or normative analyses were performed. Two subtests of CNTB could not be translated due to copyright restrictions. RESULTS: Only minor adaptations were necessary. In the RUDAS memory item, "tea" was replaced with "coffee" and "cooking oil" with "olive oil," reflecting Italian cultural familiarity. Within the CNTB, only the Enhanced Cued Recall Task and Serial Threes required clarification. CONCLUSION: The Italian versions of the RUDAS and CNTB required minimal adaptation. Future studies should assess psychometric properties, diagnostic accuracy, and normative performance in both native Italian and CALD populations.
A 69-year-old woman with a recurrent skull-base meningioma developed recurrent hypothermia during rehabilitation, initially misattributed to infection. Episodes followed a circadian pattern and were associated with delir...A 69-year-old woman with a recurrent skull-base meningioma developed recurrent hypothermia during rehabilitation, initially misattributed to infection. Episodes followed a circadian pattern and were associated with delirium, pancytopenia, and signs of central endocrine dysfunction. MRI showed a large meningioma compressing the hypothalamus with an intact corpus callosum. Infection and adrenal insufficiency were excluded. Hypothermia resolved with external warming, and pancytopenia normalized spontaneously. Subclinical hypothyroidism and central hypogonadism were noted, consistent with hypothalamic-pituitary axis involvement. These findings supported a diagnosis of acquired spontaneous periodic hypothermia (SPH) due to hypothalamic compression. This case illustrates that early recognition of SPH in patients with skull-base tumors can prevent misdiagnosis and guide appropriate supportive care and monitoring.
PURPOSE: To evaluate reliability of the Dysphagia Outcome and Severity Scale (DOSS) in Amyotrophic Lateral Sclerosis (ALS) patients, and to assess diagnostic accuracy of selected non-instrumental measures in defining swa...PURPOSE: To evaluate reliability of the Dysphagia Outcome and Severity Scale (DOSS) in Amyotrophic Lateral Sclerosis (ALS) patients, and to assess diagnostic accuracy of selected non-instrumental measures in defining swallowing safety in this population. METHODS: One hundred and thirteen consecutive ALS patients underwent comprehensive dysphagia evaluation with fiberoptic endoscopic evaluation of swallowing (FEES) and were classified according to DOSS. Safe and unsafe swallowing were defined by DOSS levels 7-6 and 5-1, respectively. Patient-reported measures included ALS Functional Rating Scale-Revised swallow item (I-3) and Eating Assessment Tool-10 (EAT-10). Non-instrumental clinical measures were hyolaryngeal excursion, voluntary cough (VC), voice quality and reflexive cough/throat clearing (VRC), and maximum phonation time (MPT). Inter- and intra-rater reliability were assessed using weighted Cohen's kappa and Fleiss' kappa coefficients. Non-instrumental measures diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: Twenty-six of 113 patients (23%) exhibited an unsafe swallowing. Inter- and intra-rater agreement for DOSS classification was excellent across raters. EAT-10 and a composite clinical index derived from VC, VRC, and MPT showed the highest diagnostic accuracy with area under the curve values of 0.790 and 0.832, respectively. Other non-instrumental measures demonstrated lower discriminative performance. CONCLUSIONS: The DOSS showed an excellent reliability when applied to FEES in patients with ALS, supporting its use as a functional classification tool with direct nutritional and management implications. Non-instrumental measures should be interpreted with caution and confined to a triage role rather than diagnostic decision-making, particularly in light of the rapid progression of dysphagia in ALS.